In lung adenocarcinoma diagnosed as clinical N0 by chest computed tomography and positron emission tomography scanning, the possibility of occult lymph node metastasis increases with SUVmax greater than 5 and when lymphatic invasion, vascular invasion, and a micropapillary component are present.

Objective The purpose of our study was to assess the differentially diagnostic value of radiographic characteristics of pure ground glass nodules (GGNs) between minimally invasive adenocar-cinoma and non-invasive neoplasm. Methods Sixty-seven pure GGNs (28 minimally invasive adenocarcinomas (MIA) and 39 pre-invasive lesions) were analyzed from June 2012 to June 2015. Pre-invasive lesions consisted of 15 atypical adenomatous hyperplasia (AAH) and 24 adenocarcinomas in situ (AIS). High-resolution computed tomography (HRCT) features and volume of MIA and pre-invasive lesions were assessed. Fisher exact test, independent sample t test, Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were performed. Results Inter-observer agreement indexes for the diameter, mean HRCT attenuations and volume of pure GGNs were all high (ICC>0.75). Univariate analyses showed that lesion diameter, mean HRCT attenuation, and volume value differed significantly between two groups. Among HRCT findings, GGN shape as round or oval (F = 13.456, P = 0.002) and lesion borders as smooth or notched (F = 15.742, P = 0.001) frequently appeared in pre-invasive lesions in comparison with MIA. Type II and type III of the relationship between blood vessels and pure GGNs suggested higher possibility of malignancy than type I. (2017) Can we differentiate minimally invasive adenocarcinoma and non-invasive neoplasms based on high-resolution computed tomography features of pure ground glass nodules? PLoS ONE 12(7): e0180502. https://doi.org/10.

Background: The prognosis of non-small cell lung cancer (NSCLC) presenting as a ground glass opacity (GGO) nodule is better than other types of lung cancer. The purpose of this study was to evaluate the necessity of mediastinal lymph node evaluation (MLE) in clinical N0 GGO-predominant NSCLC. Methods:We conducted a retrospective chart review of 358 patients treated for clinical N0 NSCLC that was found by curative resection to be 3 cm or smaller in size. We analyzed clinicopathological findings and survival among three groups with either GGO-predominant or solid-predominant tumor: no mediastinal lymph node evaluation (NoMLE) group, mediastinal lymph node sampling (MLS) group, and mediastinal lymph node dissection (MLND) group.Results: Except for sex, there were no differences in clinicopathological characteristics among the three groups with GGO-predominant tumor or solid-predominant tumor. There was no difference in the 5-year recurrence-free survival (RFS) rate among three groups in the GGO-predominant patients (100%, 92.9%, 93.8%, respectively; P=0.889). However, in the solid-predominant tumor group, the 5-year recurrence free survival of the NoMLE group was lower than in the MLND group (48.6% vs. 73.1%, P=0.007). MLE was not a significant risk factor for recurrence in GGO-predominant tumor [hazard ratio (HR) =1.021; P=0.987].GGO-predominant tumor [odds ratio (OR) =0.063; P=0.008] was identified as the sole parameter that significantly impacted nodal upstaging.Conclusions: MLE is not an essential procedure for clinical N0 NSCLC presenting as a 3 cm or smaller GGO-predominant nodule.

Background: Ground-glass opacity (GGO) on chest computed tomography (CT) is generally associated with non-invasive or minimally invasive adenocarcinoma (MIA). However, many instances of GGO are diagnosed as invasive adenocarcinoma. The purpose of this study is to analyse the histopathologic characteristics of invasive adenocarcinoma presenting as GGO and the prognosis after sublobar resection. Methods: We conducted a retrospective chart review of 191 patients who were treated for stage I nonsmall cell lung cancer presenting as a GGO-predominant tumour upon CT and who underwent curative resection. We analysed the histologic subtypes and components of invasive adenocarcinomas presenting as GGO-predominant tumours. We also compared the 5-year recurrence-free survival (RFS) of invasive adenocarcinomas presenting as GGO-predominant in patients undergoing sublobar resection or lobectomy. Results: Of 191 GGO-predominant tumour patients, 97 patients had adenocarcinoma in situ (AIS) or MIA, and 94 patients had invasive adenocarcinoma. In the analysis of the histologic component of invasive adenocarcinoma presenting as GGO, the mean rate of the lepidic component was 47.4%, that of the acinar component was 42.1%, and that of the papillary component was 7.3%. Micropapillary and solid components were nearly absent. The 5-year RFS rates of sublobar resection and lobectomy were both 100%. Conclusions: Invasive components such as acinar and papillary components can also be seen as GGO tumours on chest CT. After the sublobar resection of GGO-predominant tumours, a good prognosis can be expected, even if the tumour is an invasive adenocarcinoma such as the acinar or papillary subtypes.

Background In the seventh edition TNM staging system for lung cancer, a high maximum standardized uptake value (SUVmax) on positron emission tomography was regarded as a risk factor for occult lymph node metastasis in clinical T1N0 non‐small cell lung cancer (NSCLC). However, in the eighth edition TNM classification, tumors are classified according to the size of the invasive component only, and those with invasive component size ≤3 cm are diagnosed as stage T1. The aim of this study was to reassess the risk factors for occult lymph node metastasis under the eighth edition TNM classification for lung cancer. Methods From 2010 to 2017, 553 patients with clinical N0 peripheral NSCLC with invasive component size ≤3 cm underwent anatomical lobectomy with systematic lymph node dissection. We analyzed these cases retrospectively to identify risk factors for postoperative nodal upstaging. Results Among 553 study patients, 54 (9.8%) had nodal upstaging after surgery. In multivariate analysis adopting the eighth edition TNM classification for lung cancer, serum carcinoembryonic antigen (CEA) level (hazard ratio [HR] = 1.113, p = 0.002), invasive component size (HR = 2.398, p = 0.004), visceral pleural invasion (HR = 2.901, p = 0.005), and lymphatic invasion (HR = 9.336, p < 0.001) were significant risk factors for nodal upstaging, but SUVmax was not. Conclusion SUVmax is not a predictor of nodal upstaging in clinical N0 peripheral NSCLC with invasive component size ≤3 cm under the eighth edition TNM classification for lung cancer. Significant risk factors of occult lymph node metastasis are serum CEA level, tumor invasive component size, visceral pleural invasion, and lymphatic invasion.

The width between the tumor and resection margin does not affect the recurrence after R0 sublobar resection in patients with clinical N0 GGO-predominant lung cancer ≤3 cm. By contrast, margin width is a significant risk factor for recurrence after sublobar resection in patients with clinical N0 solid-predominant lung cancer.

BackgroundStage I pulmonary adenocarcinoma (PA) can offer an unfavorable prognosis. The aim of this study was to classify the prognosis of stage I PA on the basis of the lepidic component and to confirm whether the lepidic component can be used as a criterion for predicting the prognosis of stage I PA.MethodsWe conducted a retrospective study of patients who underwent curative surgery for stage I and IIA PA. Stage I disease was divided into three groups on the basis of the lepidic component: group 1, ≤10 %; group 2, >10 to 50 %; and group 3, >50 %. We compared recurrence-free survival (RFS) rates among groups 1, 2, and 3, and stage IIA disease. We also evaluated risk factors for disease recurrence with multivariate analysis.ResultsA total of 224 patients were included in our study; most patients (n = 201) had stage I disease. Three-year RFS rates in group 1 (n = 73), group 2 (n = 75), and group 3 (n = 53) were 74.1, 90.4, and 90.0 %, respectively. There was a significant difference in RFS between group 1 and group 2 (p = 0.009). The 3-year RFS rate in stage IIA disease was 61.4 %. There were no significant differences in RFS between group 1 and stage IIA disease (p = 0.163). In multivariate analysis, group 1 had the highest risk of recurrence (HR 5.806, p = 0.006) in stage I PA.ConclusionsStage I PA with a lepidic component ≤10 % was associated with an unfavorable prognosis that was similar to the prognosis of stage IIA disease. The prognosis for stage I PA should not be based on general criteria, but instead, the lepidic component should be evaluated and considered when determining disease prognosis.

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